The Dental Benefit provides coverage for certain oral surgical procedures and courses of treatment following accidental injury. Eligible expenses under the Dental Benefit are the reasonable and customary charges for these services and procedures when performed by a dentist or dental surgeon.
Lower cost alternative
When two or more courses of treatment for oral procedure or accidental injury are considered appropriate, the Plan will pay for the treatment that is least expensive.
If you choose to have the more expensive treatment, the Plan will only reimburse you up to the amount quoted for the less expensive treatment, as long as the treatment you choose is not excluded under the Plan.
Order of claiming
For oral surgery:
If you are covered under the Public Service Dental Care Plan, the Dependants Dental Care Plan, the CF Dependants Dental Care Plan or the Pensioners' Dental Services Plan, you must submit your claims for oral surgery to that plan first. Any amount not covered by your dental plan may then be submitted to the PSHCP.
You should submit your claims for accidental injury expenses to the PSHCP first.
Expenses for treatment of accidental injury
The Plan covers the services of a dental surgeon and charges for dental prosthesis when required for the treatment of a fractured jaw or accidental injuries to natural teeth if the fracture or injury was caused by an external, violent and accidental injury or blow. The Plan does not cover injuries associated with normal acts such as cleaning, chewing and eating.
Treatment must occur within 12 months following the accident or, in the case of a dependant child under 17 years of age, before attaining 18 years of age.
This time limit may be extended if, as determined by Sun Life, the treatment could not have been rendered within the time frame specified.
A physician's prescription is not required.
Expenses for oral surgical procedures
|Procedure category||Specific procedure|
|Cysts, lesions, abscesses||
Excision of cysts
Incision and drainage
|Gingival and alveolar procedures||
|Removal of teeth or roots||
Removal of impacted teeth
|Fractures and dislocations||
Dislocation—temporomandibular joint (or jaw)
Fractures—maxillar or malar
Avulsion of nerve—supra or infra-orbital
Treatment of traumatic injuries
No benefit is payable for:
- expenses identified in the General Exclusions and Limitations of the Plan
- expenses for treatment of accidental injuries to natural teeth and oral surgical procedures other than those identified
- accidental injuries associated with normal acts such as cleaning, chewing and eating
- expenses for dental cleaning and maintenance services
- braces, retainers, headgear and other dental devices